Diabetes care: 10 ways to avoid complications

Healthy Living
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Here are 10 ways to take an active role in diabetes care and enjoy a healthier future.

1. Commit to managing your diabetes
Learn all you can learn about diabetes.
Your diabetes care team can help you learn the basics of diabetes care and offer support along the way, but you are the player, you make the calls.

2. Don’t smoke
Smoking increases your risk of type 2 diabetes and the risk of various diabetes complications, including:

  • Reduced blood flow in the legs and feet, which can lead to infections, ulcers and possible removal of a body part by surgery (amputation)
  • Heart disease
  • Stroke
  • Eye disease, which can lead to blindness
  • Nerve damage
  • Kidney disease
  • Premature death

3. Keep your blood pressure and cholesterol under control
High blood pressure can damage your blood vessels. High cholesterol is a concern, too, since the damage is often worse and more rapid when you have diabetes. When these conditions team up, they can lead to a heart attack, stroke or other life-threatening diseases.

4. Schedule regular physicals and eye exams
Schedule two to four diabetes checkups a year, in addition to your yearly physical and routine eye exams. Your eye care specialist will check for signs of retinal damage, cataracts, and glaucoma.

5. Keep your vaccines up to date
Ask your doctor about:
Flu vaccine. A yearly flu vaccine can help you stay healthy during flu season as well as prevent severe complications from the flu.

Pneumonia vaccine. Sometimes the pneumonia vaccine requires only one shot. If you have diabetes complications or you’re age 65 or older, you may need a booster shot.
Hepatitis B vaccine. The hepatitis B vaccine is recommended for adults with diabetes who haven’t previously received the vaccine and are younger than 60. If you’re age 60 or older and have never received the hepatitis B vaccine, talk to your doctor about whether it’s right for you.

Other vaccines. Stay up to date with your tetanus shot (usually given every 10 years). Your doctor may recommend other vaccines as well.

6. Take care of your teeth
Diabetes may leave you prone to gum infections. Brush your teeth at least twice a day with fluoride toothpaste, floss your teeth once a day and schedule dental exams at least twice a year.

7. Pay attention to your feet
High blood sugar can reduce blood flow and damage the nerves in your feet. Left untreated, cuts and blisters can lead to severe infections. Diabetes can lead to pain, tingling or loss of sensation in your feet.

To prevent foot problems:

  • Wash your feet daily in lukewarm water. Avoid soaking your feet, as this can lead to dry skin.
  • Dry your feet gently, especially between the toes.
  • Moisturize your feet and ankles with lotion or petroleum jelly. Do not put oils or creams between your toes — the extra moisture can lead to infection.
  • Check your feet daily for calluses, blisters, sores, redness or swelling.
  • Consult your doctor if you have a sore or other foot problem that doesn’t start to heal within a few days. If you have a foot ulcer — an open sore — see your doctor right away.
  • Don’t go barefoot, indoors or outdoors.

8. Consider a daily aspirin
If you have diabetes and other cardiovascular risk factors, such as smoking or high blood pressure, your doctor may recommend taking a low dose of aspirin every day to help reduce your risk of heart attack and stroke. Ask your doctor whether daily aspirin therapy is appropriate for you, including which strength of aspirin would be best.

9. If you drink alcohol, do so responsibly
Alcohol can cause high or low blood sugar, depending on how much you drink and whether you eat at the same time. If you choose to drink, do so only in moderation, which means no more than one drink a day for women of all ages and men older than 65 and two drinks a day for men age 65 and younger.

Always drink with a meal or snack, and remember to include the calories from any alcohol you drink in your daily calorie count. Also, be aware that drinking can lead to low blood sugar later, especially for people who use insulin.

10. Take stress seriously
If you’re stressed, it’s easy to neglect your usual diabetes care routine. To manage your stress, set limits. Prioritize your tasks. Learn relaxation techniques.
Get plenty of sleep. And above all, stay positive. Diabetes care is within your control. If you’re willing to do your part, diabetes won’t stand in the way of an active, healthy life.

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You had me up to 9.

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Not sure why men get to have all the fun… I’m stuck with only 1 glass of wine!

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They make bigger glasses for women.

In all seriousness though, I think #10 is extraordinarily underrated

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An excellent article. Right on all points. One additional suggestion. Blood glucose meters, insulin pumps and CGM units have software to load-up the data in the specific unit. There are two (2) organizations that can be used for a comprehensive view of all of the above external equipment. One is Diasend and the second is Tidepool. My experience is with Diasend based upon the fact that my Endo was part of a major hospital. It sure beats having to print out all the paperwork of reports. Oh, and btw Diasend will also upload Fitbit data. There is an amazing two page summary report.

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And the most important of all, and I’d argue it comes in high above all the others… reduce carbs! Carbs is our Kryptonite and elevated blood sugars is linked to a whole host of complications. In fact point number 2 probably applies equally to high blood sugars.

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That may work for you, so go for it!

For me, I place carbs and the amount of carbs firmly into #1, because I have committed to manage and accept that diabetes is firmly woven into my life.

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I eat very few carbs but the ones I do eat are firmly in category 1. I too, have committed to manage and accept that diabetes is firmly woven into my life, and for that reason I decided not to eat carbs. I have no issue with you eating carbs but generally speaking diabetics do better the less carbs they eat. Like I said - they are our Kryptonite. So I don’t say you ‘must’, but the advice for diabetics to reduce their carb intake is undeniably good advice. I used to be a smoker but I never took offence at the advice to reduce or cut it out altogether because I knew it to be true. I chose to smoke but I knew it was a bad idea. I think carb consumption is much the same thing.

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No, it is not anywhere close to the same thing. Carbs and how they play into your protocol are very much a YDMV thing. You do you.

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Carbs are a hard thing for me to limit. There are so many reasons for eating low on the food chain right now (global warming, etc.) that I would feel bad adding a low carb diet to the other costs of managing my diabetes: E.g. excess plastic waste, Because I am physically active, I sometimes eat over 300 grams/day of carbs. So far I haven’t incurred any costs in the form of diabetes complications. I’d like to hear more from type 1high-carb diet eaters about your trials and tribulations and how you manage to maintain good control.

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I run what appears to be a relatively high carb diet and like you, I’m pretty active, so carbs make it easier for me to manage the low side of the D-wave. I know there are some who are also very active and are fairly low carb, but I haven’t been able or willing to make that work for me.

Managing it all? The biggest plus for me has been a combo of having a CGM and a pump.

When I combine the trending info, my experience with the effects of activity, and the ability to run temporary basal rates, extended boluses, square wave, etc, I have been able to limit my hyper excursions pretty well.

My biggest problem? Hypo excursions, I am having too many! However, I do think that my Dex overreports and I know I get compression lows at night (aka, false lows), so I’m thinking I still have some minor tweaking to do to bring them up to more acceptable levels.

Specific tactics include situational pre-bolusing.

For example, this morning I woke to 79 mg/dl (4.4 mmol). When I bolused 1.6U for a banana w/34g carb, I only waited 5 minutes before eating. If I were between 81 - 95 mg/dl (4.5 - 5.3 mmol), I would have waited 10 - 15 minutes. If I were @ 120 (6.6), I would have waited 20 - 25 minutes. I also use my Dex for the start of a downward trend. I fully expect to peak as high as 175 mg/dl (9.7 mmol), but I also expect that I will end up under 100 (5.5). However, since bananas are notorious for having widely variable carbs depending on ripeness, I am ready to bolus a bit more as I watch my trending data.

Here’s a screen shot from a recent Dex AGP report:

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Screen Shot 2018-06-06 at 8.49.36 AM.jpg1136×1044 294 KB

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The list is missing a biggie! Where is exercise regularly? Regular exercise increases insulin sensitivity, burns calories, lowers ( in most cases) bg, lowers blood pressure, increases cardiovascular fitness, and can reduce stress. I balance food consumption with exercise so that if I really want a slice of pizza, I have to “work it off”. As I’m counting carbs, I’m also counting blocks to be walked to work it off.

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Excellent suggestion! Now, we just need another to make it an even dozen or if there are two more, a baker’s dozen!